The often heart-breaking mutually destructive relationship between insulin resistance and PCOS(1)
With over 3.5 million South Africans suffering from diabetes and an estimated further 5 million with pre-diabetes, most of whom are currently undiagnosed(2), the situation in South Africa is dire.
Prediabetes is a condition which occurs when your blood glucose levels are higher than normal but not high enough to be diagnosed with actual diabetes. Prediabetes usually occurs in people who already have some insulin resistance(3). Cells in your body use glucose for energy, Glucose in your body is transported into your cells with the help of the hormone insulin. Insulin resistance is when cells in your muscles, fat, and liver do not respond well to insulin and cannot easily take up glucose from your blood(3). In response, your pancreas releases more insulin and as a result, both insulin and glucose begin to accumulate in the bloodstream(1).
While many of us might be aware of the fact that insulin resistance may be a precursor to diabetes(1, 3) and that excess weight and lack of physical activity could be at fault(3), how many of us are aware of the relationship between insulin resistance and polycystic ovary syndrome (PCOS)?
PCOS is a common reproductive disorder(4) that affects as many as 15% of the female population(5). It is defined as a hormonal disorder common among women of reproductive age(6).
According to statistics 60-80% of women with PCOS suffer from insulin resistance(4).
“I would describe the relationship between insulin resistance and PCOS as mutually destructive in that PCOS worsens insulin resistance and vice versa,” says Dr Carmen James, an integrative medical doctor and holistic health and wellness coach from Durban(1).
Dr James explains that while high insulin levels are a feature of PCOS, they also fuel the disease. “The reason for this is because insulin accumulation reduces ovulation and promotes the production of androgens or male hormones. This results in symptoms such as a male pattern of hair growth (hirsutism), acne and in some cases is associated with difficulties with fertility,” she says(1).
In fact, 60% of women with PCOS suffer from hair loss, acne and unwanted hair growth and 20% have infertility problems(4).
Alarmingly, more than 50% of women with PCOS will develop diabetes or pre-diabetes before the age of 40(7).
With so many women affected by PCOS or insulin resistance, or indeed both(4), the effect on fertility can be heart-breaking. But exactly how does having insulin resistance affect fertility?
Dr James explains that ovulation occurs during a normal menstrual cycle where an egg is released from the ovary and passes through the fallopian tubes and into the uterus. If the egg is not fertilised, the egg, together with the uterine lining, will be shed during menstruation(1).
“Because an accumulation of insulin in the bloodstream elevates androgen levels, the resulting hormone imbalance will negatively affect ovulation. When women do not ovulate, they may menstruate less frequently, have irregular cycles and in some instances, they may not menstruate at all. If an egg is not released into the uterus, conception will not occur”, she says(1).
PCOS is the most common cause of irregular menstruation that leads to infertility(4).
While it is more likely for overweight and obese women to experience insulin resistance(1) and PCOS(6), women of a normal weight can be affected too. “It is important to remember that weight alone is not an absolute representation of health,” Dr James says(1).
Dr James, who runs various workshops around the country on women’s health with a special focus on hormone health, strongly recommends that women with PCOS and/or insulin resistance address the underlying root cause drivers of their condition. “While we cannot control our genes, we can aim to live a healthy lifestyle to reduce the negative effects of both PCOS and insulin resistance. I recommend following a healthy diet, rich in plant-based foods and low in refined carbohydrates; enjoying regular physical exercise; adding supplements including myo-inositol, curcumin, antioxidants, folate and berberine; managing stress levels and getting good quality sleep,” she says and explains that these measures will reduce inflammation, improve insulin sensitivity and begin to bring balance to the hormones to support ovulation(1).
A new supplement
A new supplement with ingredients proven to help correct endocrine and metabolic imbalances linked to insulin resistance and infertility in women with PCOS was launched in South Africa in August 2019(8,9,10,11).
Sinopol® is available over the counter at Dischem, Clicks and leading pharmacies without a prescription, contains a unique combination of 3 ingredients which include the antioxidant Alpha Lipoic Acid (400mg), Myo-Inositol (1000mg) and Folic Acid (200µg)(12).
This combination of ingredients in various studies on certain patient profiles have demonstrated success in reducing insulin resistance, reducing obesity and increasing pregnancy rates in patients undergoing invitro fertilization cycles.(8.9.10)
The recommended retail price is around R370 but prices may vary depending on where you go.
Speak to your doctor or pharmacist or go to www.sinopol.co.za for more information.
Visit Sinopol South Africa’s Facebook page www.facebook.com/SinopolSA
This editorial has been commissioned and brought to you by iNova Pharmaceuticals. Content in this editorial is for general information only and is not intended to provide medical or other professional advice. For more information on your medical condition and treatment options, speak to your healthcare professional.
Further information is available on request from iNova Pharmaceuticals. Name and business address: iNova Pharmaceuticals (Pty) Ltd. Co. Reg. No. 1952/001640/07. 15E Riley Road, Bedfordview. Tel. No. 011 087 0000. www.inovapharma.co.za. IN3560/19
- Q&A with Dr Carmen James. 10 October 2019 (unpaid)
- IOL. World Diabetes Day (2018) at https://www.iol.co.za/the-star/news/worlddiabetesday-about-35m-south-african-suffer-from-diabetes-18095274 (website accessed on 16 October 2019)
- National Institute of Diabetes and Digestive and Kidney Diseases. Insulin Resistance and Prediabetes (2018) athttps://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes/prediabetes-insulin-resistance(websiteaccessed on 16 October 2019)
- Barthelmess EK, Naz RK. Polycystic ovary syndrome: current status and future perspective. Front Biosci (Elite Ed). 2014 Jan 1;6:104-19.
- Web MD. Why is PCOS hard to diagnose (2016) at https://www.webmd.com/women/features/pcos-polycistic-ovary-syndrome-women#1 (Website accessed on3 July 2019)
- Mayo Clinic. Polycystic ovary syndrome (2017) at https://www.mayoclinic.org/diseases-conditions/pcos/diagnosis-treatment/drc-20353443 (Website accessed on3 July 2019)
- Medical News Today. What to eat if you have PCOS (2018) at https://www.medicalnewstoday.com/articles/323002.php (Website accessed on3 July 2019)
- Rago R, Marcucci I, Leto G, et al. Effect of myo-inositol and alpha-lipoic acid on oocyte quality in polycystic ovary syndrome non-obese women undergoing in vitro fertilization: a pilot study. J Biol Regulators Homeostatic Agents 2015;29(4):1-11.
- Genazzani AD, Shefer K, Della Casa D, et al. Modulatory effects of alpha‑lipoic acid (ALA) administration on insulin sensitivity in obese PCOS patients. J Endocrinol Invest 2018;41:583–590.
- Carbonelli MG, Di Renzo L, Bigioni M, et al. α-Lipoic Acid Supplementation: A Tool for Obesity Therapy? Curr Pharmaceut Design 2010;16:840-846.
- De Cicco S, Immediata V, Romualdi D, et al. Myoinositol combined with alpha-lipoic acid may improve the clinical and endocrine features of polycystic ovary syndrome through an insulin-independent action. Gynecol Endocrinol 2017;33(9):698–701.
- Sinopol(R) package insert, February 2019.